Understanding facial ageing

Facial ageing is often described as though it were simply a problem of loose skin.

It is not.

The appearance of an ageing face is the combined result of changes in several anatomical layers.

The face should be evaluated as connected regions

Patients naturally notice individual features.

But these areas are anatomically connected.

Treating one region without understanding the neighbouring structures can create an incomplete result.

For this reason, facial assessment usually considers the face in several related zones.

Upper face and brow

Changes in brow position and forehead anatomy can influence the appearance of the upper eyelids and eyes.

A low or descended brow may create heaviness above the eye that cannot always be corrected by removing upper-eyelid skin alone.

Depending on the anatomy, treatment might involve upper blepharoplasty, brow lift, or a more conservative approach.

The important point is determining where the apparent heaviness actually originates.

Eyes and eyelids

The eyelid area contains some of the most delicate anatomy in facial surgery.

Ageing may involve:

• Excess upper-eyelid skin
• Protruding or displaced fat
• Lower-eyelid bags
• Hollowing beneath the eyes
• Weakening of lower-eyelid support
• Changes in the transition between the eyelid and cheek

Not every “eye bag” is simply excess fat, and not every hollow should automatically be filled.

A successful eyelid treatment should preserve the identity and expression of the eyes rather than making them look operated.

Midface and cheeks

The cheek is one of the central structural regions of the face.

Changes in cheek volume and position can alter:

• The eyelid–cheek junction
• Nasolabial folds
• Facial width
• Lower-face heaviness
• The apparent depth of the tear trough

In some patients, the problem is primarily volume loss.

In others, it is tissue descent.

Frequently it is a combination.

These are not necessarily treated in the same way.

Adding large amounts of volume to descended tissue, for example, may increase facial heaviness rather than restore youthful structure.

Jawline and lower face

Loss of jawline definition is one of the most common reasons patients begin considering facial surgery.

However, a blurred jawline may result from several different anatomical factors:

• Descent of facial tissues
• Skin laxity
• Jowl formation
• Excess subcutaneous fat
• Limited chin projection
• Neck ageing
• Differences in skeletal anatomy

This is why “jawline surgery” is not one operation.

For some patients, lower-face lifting is the important element. For others, neck treatment may contribute more.

Occasionally chin proportions or localised fat distribution are part of the picture.

The correct solution depends on the cause.

Neck

The face and neck should rarely be evaluated completely independently.

Changes beneath the chin and along the neck can influence the apparent definition of the entire lower face.

A neck lift may sometimes be performed alone, but in patients with significant lower-face ageing, the relationship between the face and neck becomes particularly important.

Treating one while ignoring the other can leave an obvious transition.

Volume loss is not always a lifting problem

One of the most important distinctions in facial aesthetics is the difference between tissue descent and volume loss.

They can look similar.

A hollow temple, flattened cheek or deeper transition beneath the eye may result partly from loss of volume rather than loose tissue.

In selected patients, facial fat transfer may therefore form part of a broader rejuvenation plan.

But volume should not be used to camouflage every sign of ageing.

Excessive filling can distort proportions, particularly when the underlying problem is tissue descent rather than true deficiency.

When is a facelift considered?

A facelift is generally considered when ageing has affected deeper tissues of the lower face and jawline rather than the skin alone.

Depending on the patient’s anatomy and the surgical technique, treatment may address:

• Jowling
• Lower-face descent
• Reduced jawline definition
• Changes in facial soft-tissue position
• Associated neck ageing

The purpose should not be to create a tighter-looking face.

A well-planned facelift aims to restore more coherent anatomical relationships while preserving facial identity.

Different facelift techniques exist, including approaches that work at different anatomical planes.

The name of the technique, however, is less important than whether it appropriately addresses the patient’s anatomy.

When surgery may not be the right answer

Not every concern visible in the mirror has a surgical solution.

Sometimes the most appropriate surgical decision is to wait.

That is still a clinical decision.

Natural facial surgery is largely about restraint

One of the difficulties of facial aesthetic surgery is that the face is highly recognisable.

Small changes in eyelid shape, cheek volume, brow position or facial tension can significantly alter how a person looks.

The objective should therefore not be to remove every sign of ageing.

Expressions, natural asymmetries and individual facial characteristics should remain recognisable.

This requires a degree of restraint.

How Dr. Mert Demirel approaches the face

The consultation is not designed to identify the maximum number of procedures that can be performed.

It is intended to identify the smallest coherent treatment plan capable of addressing the patient’s actual anatomical concerns.

The aim is not to design a different face. It is to make a precise decision about the existing one.

Choosing the right facial procedure

Patients frequently arrive at consultation with the name of a procedure already in mind.

That can be a useful starting point, but it should not determine the operation.

The consultation should therefore answer a more useful question:

What anatomical change is responsible for what you are seeing?

Only then does the procedure become relevant.